Nearly 8% of US health care personnel (HCP) with symptomatic COVID-19 continued to work during their illness, and the practice became increasingly common as the pandemic progressed, suggests a new observational cohort study published in JAMA Network Open.
The analysis drew on data from a case-control vaccine effectiveness study that enrolled HCP who had COVID symptoms across 24 academic medical centers from December 2020 through April 2024. Among 3,721 HCP with confirmed COVID symptoms, 293 (7.9%) reported presenteeism, defined as working while sick. The researchers observed a clear upward trend in presenteeism over time, rising from 1.4% in 2020 to 15.2% in 2024.
Staff with grad degrees more likely to work while ill
Presenteeism varied by job role. HCP with minimal patient contact were more likely to continue working than those whose jobs involved substantial patient contact. These workers may perceive less risk of transmitting infection or find it easier to continue working while isolating, note the study authors.
Socioeconomic factors also played a role. HCP with graduate or professional degrees were significantly more likely to report presenteeism than those with an undergraduate education, as were those earning more than $100,000 annually compared with those earning under $50,000. The team found no statistically significant difference in age, sex, race, or ethnicity between those who stopped working when they had symptoms and those who didn’t.
The more severe an employee’s symptoms, the less likely they were to continue to work. HCP reporting shortness of breath had substantially lower odds of presenteeism, and symptoms, including fever, fatigue, headache, nausea, and muscle aches, were associated with a reduced likelihood of working while ill.
The authors suggest several explanations for why presenteeism has trended upward since the onset of the pandemic, including greater population-wide immunity, milder disease with later variants, shorter suggested isolation windows, and expanded options for remote or hybrid work.
Presenteeism remains a top concern in health care settings
Early in the COVID pandemic, numerous outbreaks in hospitals and long-term care facilities were traced to symptomatic HCP. Even as COVID severity has declined, presenteeism among HCP remains a concern, particularly given the risks it poses to people with compromised immune systems.
The study did not look at access to paid sick leave, workload pressures, or whether work was performed remotely—all factors that would help highlight why some HCP continue to work when sick.
The authors conclude, “More studies are needed to understand the rationale behind the decision to continue working and the exact causes of presenteeism’s rising incidence among HCP with COVID-19.”
